The delays and technical problems associated with the launch in June of the new e-Referral Service are well known. Do these threaten to derail the project? Our view is ‘no’. ERS is a cornerstone of the NHS Paperless by 2018 strategy. The HSCIC is currently working hard to iron out bugs and the system is stabilising. Despite recent hiccups, the concept of a national ‘exchange’ for referrals continues to be valid. Interestingly, we believe that the current focus on cost savings is likely to make ERS an even more important tool for CCGs. Without a centralised platform, commissioners cannot manage (directly or via third parties) referrals effectively; similarly an increasing number of prime contractors and AQPs need this platform to work effectively. A successful e-Referral Service platform should be the basis for proactive NHS referral management to deliver better outcomes at lower cost.
As an independent software company, we welcome HSCIC’s vision of a more open solution based on interoperability standards. In the coming years, we are excited about expanding our software solutions that help commissioners and providers better leverage ERS whilst automating many manual processes to reduce costs.
This short blog first looks at the history of Choose & Book and then looks at the future of the new e-Referral Service. We conclude by looking at the type of services that psHEALTH is developing for CCGs, prime contractors and providers to enable them to leverage ERS.
Choose & Book: A decent success
Choose & Book was launched in 2005 in the wake of healthcare reform and the NHS constitution championed by Tony Blair. Central to the reform were the splitting of provider and commissioning activities and increased patient choice in secondary care.
Choose & Book was developed as one of the strands of the National Program for IT. It may well be remembered as a success relative to the overall disastrous £10 billion plus program that was largely written off. The solution was delivered by the system integrator Atos. And despite all the criticism for being clunky and slow, eventually almost half of all referrals to secondary care were processed through C&B. It was used by about 40,000 patients every day to book hospital appointments online, although another 40,000 still chose to rely on paper-based referrals. Paper referrals are ‘dangerous’, in Wales alone a study found that inside one year over 13,000 paper referrals were lost.
The new e-Referral Service: Out of intensive care
The upgrading of Choose & Book was announced to great fanfare in 2013. HSCIC decided to ‘own and manage’ the system. Tight time lines and grand visions for new functionality were initially set out. Following a seven month delay announced in October 2014 a month before the system was due to go live, the new e-Referral Service was finally launched in June 2015. In this blog we are not going to dwell on the fact that the system was not actually ready at launch resulting in several months of major disruption. The good news is that ERS is now out of intensive care; HSCIC has delivered a new solution and that time and budget over-runs have probably been modest compared to other big NHS projects. 
The future is bright: Referral Management is the future
Given the rapidly increasing pressure on commissioners, a passive referral management approach (relying on guidelines and anecdotal evidence) is not an option when patient care and financial viability are at risk. These organisations need to develop pro-active, dedicated referral management capabilities supported by advanced technology.
The biggest challenge in Referral Management is to standardise the process with clearly defined incoming paths and clearly defined pathways. Today’s situation with huge variability in the usage of ERS and a number of poorly defined referral interfaces (think Consultant-to-Consultant referrals), makes it very hard for commissioners, prime contractors and other providers. We encourage the NHS England, HSCIC and individual CCGs to work very hard together to make ERS the only way to make a referral.
The end goal must be that every single referral to secondary care will go via ERS and that no CCG or prime contractor is paid unless this referral process has been followed.
Our friendly advice to HSCIC: Focus on take-up and interoperability
As the ERS idea was launched in 2013, it was easy to get carried away with all the functionality that the new system would deliver. Now that the rubber has hit the road, we have two pieces of friendly advice to the HSCIC:
Going forward, HSCIC’s most important job is to ensure usage of ERS. The goal should be achieving acceptance as this is the only method of making a referral (whether as a GP or a Consultant).
Avoid the temptation of building ever more functionality: we are hoping the launch delays and subsequent technical problems will re-inforce the view that ERS should focus on being a high performing, secure and reliable platform. HSCIC should concentrate on interoperability and providing a level playing field to ensure that software vendors and partners develop innovative bolt-ons or platform extensions.
We welcome HSCIC’s open philosophy and believe that by providing a stable and secure platform, the HSCIC has a unique opportunity to foster an ecosystem with innovative apps – much like Apple provides a framework with its App Store. HSCIC can achieve this by focussing on Information Governance and Interoperability.
psHEALTH: Software to Leverage ERS
At psHEALTH, our vision is to help CCGs, prime contractors and providers to effectively manage referrals to enable better pathway control, lower cost and an improved patient experience. We are already helping customers automate many aspects of referral management, including interactions with ERS. Our development focus is to continue to improve performance and flexibility of our solutions, including:
- Referral from any source: Ability to automatically capture and process referrals from email and fax (and automatically create referrals on ERS for audit purposes)
- Automation with artificial intelligence: Reduce manual input, improve data collection and reduce costs by using triage engines (using rules and natural language processing)
- Flexible configuration: Enable non-technical staff to configure and refine solution
In the long run our product vision is that our software will help support referral management from triage and pathway selection all the way to matching the original referral with clinical outcomes and the invoice from a provider. In particular, we believe we can help CCGs, prime contractors and providers in a future where – out of necessity – there is greater focus on pro-active referral management resulting in more complex rules relating to eligibility and pre-authorisation.
About psHEALTH
At psHEALTH, our vision is to help CCGs, prime contractors and providers effectively manage referrals to enable better pathway control, lower cost and an improved patient experience.
We deliver software to automate referral management – from GPs or Consultants. Our unique triage engine can fully automate the capture of referrals from both ERS (formerly Choose & Book) and email.
Click for Whitepaper: The Future of Referral Management
Or contact emma.walker@pshealth.co.uk or call us on 0845 50 50 120 to set up a discussion or system demonstration.